ON APRIL 21, Nicole Mittendorff, a 31-year-old firefighter with the Fairfax County, Virginia, Fire & Rescue, was found dead in Virginia’s Shenandoah National Park, the victim of an apparent suicide. A suicide note was found in her car; according to published reports, cyberbullying by fellow firefighters may have been a factor in her decision to take her own life. The incident is under investigation.

Nicole Mittendorff

Mittendorff’s story is the latest example of the problem of firefighter suicide; while the possibility of cyberbullying by colleagues offers a sobering variation on the problem, issues related to on-the-job stress continue to afflict firefighters and emergency responders with a host of behavioral health issues, including depression and suicide.

But there are indications that the problem, long considered taboo, is finally being pulled into the open.

Jim McKay knows all about that stress. In 2011, he was on a downward spiral; job stress was taking its toll on the third-generation firefighter, resulting in anxiety and depression. Alcohol was the only thing that would quiet his mind, he said. The year before, there had been a mass shooting at a beer distributor in his town of Manchester, Connecticut. An employee who resigned after being caught stealing opened fire, killing eight coworkers before turning the gun on himself. The sadness of that day, combined with 30 years of responding to difficult scenes and fatalities, the strain of odd hours and lack of sleep, and personal issues such as deaths in his family led McKay to wonder if he needed help. At the urging of his doctor and family, he checked himself into the Brattleboro Retreat’s Uniformed Service Program in Vermont for intensive outpatient therapy.

“I was ashamed at first,” said McKay, a firefighter/EMT with Manchester Fire-Rescue-EMS. “But all I know is that it worked for me.”

Five years later, McKay is an advocate for firefighter mental health awareness and treatment. He’s also an advocate for firefighter suicide prevention. On April 6, he was one of five panelists who gathered to raise awareness about firefighter suicide prevention at the New England Division International Association of Fire Chiefs 2016 Annual Meeting, held at NFPA headquarters in Quincy, Massachusetts.

McKay was joined by Dr. Susan Balaban and Donny Richard from the Brattleboro Retreat, the first mental health treatment center in the country to develop a program specifically for firefighters, police, military personnel, and emergency medical technicians. Other panelists included Michael Hoehn, a firefighter/EMT for Manchester Fire-Rescue-EMS and a co-worker of McKay’s; and Keith Crochiere, CEO of the EAP Network, which provides counseling to more than 100 organizations across New England.

Mental health and suicide prevention have long been taboo subjects in the fire service. Firefighters are viewed as models of strength and heroism, and the culture has typically fostered a “buck up” approach rather than “let’s talk about it.” Panelists said they’re starting to see a shift in that culture, particularly as more peer support groups are formed within departments. But there’s a long way to go.

“We’re talking about over 200 years of ‘suck it up, buttercup’—that’s not going to change overnight,” Hoehn, head of his fire department’s peer support group, told NFPA Journal. “The system isn’t perfect, but the overall culture is changing. We’re finally talking about it.”

RECOGNIZING THE PROBLEM

Firefighter suicide statistics are difficult to come by, at best. The Arizona-based Firefighter Behavioral Health Alliance (FBHA) is the only organization in the United States that tracks firefighter and EMT suicides, and even then, the reporting rate is estimated at about 50 percent nationwide, according to founder Jeff Dill.

Suicidal Thoughts and Behaviors Among U.S. Firefighters: Prevalence, Correlates, and Points of Intervention
Wednesday, June 15, 9:30 AM to 10:30 AM

Melanie Hom and Ian Stanley, Florida State University

Dill, a retired fire captain with the Palatine Rural Fire Protection District in Inverness, Illinois, near Chicago, got involved with firefighter mental health issues after Hurricane Katrina, when a fellow firefighter had trouble finding the counseling he needed to deal with the disturbing things he’d seen. The firefighter contacted his employee assistance program but was frustrated when he couldn’t find a counselor who understood what firefighters experience.

Dill went back to school for his master’s degree in counseling, then founded an organization called Counseling Services for Fire Fighters in 2009. Soon, he started getting emails from people all over the world expressing concern about firefighter suicides.

“I didn’t think we had a problem with suicides,” he said. “But when I started looking around and doing research, I realized we did.”

In 2011, Dill formed FBHA and began compiling statistics. He calls chiefs across the country to document incidents of suicide, and chiefs have started to notify him as well. Families of firefighters who have committed suicide contact him, too. He recorded 69 firefighter suicides in 2013, 110 in 2014, 116 in 2015, and 31 through mid-April of 2016, though he acknowledges that the information is only partial.

GETTING HELP

If you are in crisis and need immediate help, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). For more information on the lifeline, visit suicidepreventionlifeline.org.

For a list of online behavioral health resources for emergency responders, visit nfpa.org/behavioralhealth.

For more information on the Firefighter Behavioral Health Alliance and suicide prevention workshops for fire departments, visit ffbha.org.

According to Dill, mental health education and suicide prevention training should start in the fire academy. He estimates that only about 10 percent of fire academies address those issues in any depth.

Richard, a counselor and program outreach representative for the Brattleboro Retreat’s Uniformed Service Program, agreed. “They have to make [mental health education] mandatory and dedicate more time to it. Right now, they might spend an hour on it at the academy. A small group of people is really spreading the word. I’ve seen a lot of progress but there’s still a long way to go. The awareness is definitely out there, but day in and day out there’s still a big stigma attached to getting any kind of treatment.”

Typically, it’s not a single event that causes mental health issues or leads firefighters to commit suicide, Richard said. More often, the cause is cumulative stress over many years.

That was the case for McKay. While the mass shooting was a traumatic event, his anxiety and depression built up from years of stress. “I think with firefighters, it’s sort of a slow burn with work, as well as everyday life,” he said.

When McKay helped launched his department’s peer support team in 2012, mental health issues just weren’t talked about. There was awkwardness and resistance around the subject. Now, most people in the department can talk about their issues freely, he said.

Hoehn, who leads the peer support team now, said some departments don’t offer counseling or peer support because of limited resources. While large departments can pay for entire counseling units, smaller ones may not be able to afford it. However, a peer support group requires a very small investment, he said. His team of 10 requests only about $1,000 or $2,000 here and there from the chief for training. They’ve brought Dill in for training, and they’ve taken courses through the National Fallen Firefighters Foundation and the Fire Department of New York City on how to counsel their fellow firefighters.

“It doesn’t take a big financial commitment, but it takes a commitment. A lot of it is just being a good listener. Pay attention to your people. If you see somebody struggling, speak up,” Hoehn said. “Suicide is the worst case, but there are a lot of people hurting otherwise.”